Provider Demographics
NPI:1891859401
Name:BOSCHEN, SARA L (MS)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:L
Last Name:BOSCHEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 N WILLIAMS PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-6006
Mailing Address - Country:US
Mailing Address - Phone:417-833-9751
Mailing Address - Fax:
Practice Address - Street 1:2757 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-5263
Practice Address - Country:US
Practice Address - Phone:417-523-1319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist